Stress urinary
incontinence
is common among women worldwide and is mainly caused by obstetric
trauma to the pelvic floor muscles or lack of oestrogen after
menopause. Oestrogen treatment usually improves the condition for
postmenopausal women. Stress incontinence is characterized by
leakage of urine when the intra-abdominal pressure rises as in
coughing, sneezing, lifting, jumping or other forms of physical
activity including abdominal exercises. The leakage can be anything
from drops to teaspoons either daily or weekly depending on activity
level. Obesity or a chronic cough may increase leakage. Furthermore,
pelvic floor weakness can lead to prolapse of the uterus or vaginal
walls or anal incontinence.

The foremost choice of
treatment for stress urinary incontinence is pelvic floor or kegel
exercises. The effect of pelvic floor exercises is well documented
and has a cure or improvement rate of around 70%.

Increasing pelvic
floor strength by pelvic floor exercises has no side effects and is
a riskfree, lowcost treatment for stress urinary incontinence. EMG
biofeedback may also be useful in pelvic floor re-education.

Studies show that many
women, by verbal instruction alone, are uncertain as to the exact
location and correct contraction of their pelvic floor muscles. Up
to 50 % perform an incorrect contraction. Lack of visualization of
this internal and hidden muscle group may lead to ineffecient pelvic
floor training. It can even cause more leakage by incorrect use as
in bearing down or straining movements.

During pelvic floor
contractions, the deep stabilizing abdominal muscle Transversus
Abdominis is being activated through co-contraction. You can also
increase Transversus strength and awareness by tightening the lower
abdomen below the belly button, keeping your lumbar spine straight
and still. Hold for 10 sec while breathing normally, repeat 10 times
daily.

In cases where pelvic
floor re-education has no effect on amount or frequency of leakage,
ligamentous laxity or a hypermobile urethra may be corrected by
surgery.

Urge incontinence
is characterized by a sudden and often irresistable urge to void
combined with bladder emptying, and is caused by overactivity in the
nerves controlling the bladder muscle – the detrusor.

Some women have a
combination of stress and urge incontinence with one dominant
component.

Bladder training,
electrical stimulation and medicin designed to depress bladder
activity are different choices of treatment. Pelvic floor exercises
and strength also help in retaining the urge until you reach the
toilet.